The Collaborative Pediatric Critical Care Research Network (CPCCRN) is a highly productive research network that is essential to advancing the science and practice of pediatric critical care medicine. The overall aim of this renewal application is for Wayne State University (WSU), under the leadership of Kathleen Meert, MD, to continue as a clinical site in the CPCCRN. Dr. Meert, PI for the CPCCRN at WSU for the past 10 years, is a pediatric intensivist with a wealth of clinical and translational research experienc and an established track record of scientific publications for the CPCCRN. Additionally, Dr. Meert has demonstrated research expertise in behavioral medicine and communication science. Strengths of WSU as a clinical site include the Children s Hospital of Michigan (CHM), a free-standing, tertiary care, academic children s hospital offering the full spectrum of pediatric and surgical subspecialty services. The PICU at CHM is a 38-bed multidisciplinary unit that cares for >1500 patients/year with diverse racial and ethnic backgrounds. Over 85% of PICU patients have follow-up within the institution. CHM is an American College of Surgeons verified Level 1 Pediatric Trauma Center and an American Burn Association verified Burn Center. Additional strengths of WSU include its vast experience with federally-funded multicenter research networks such as the Neonatal Network, Adolescent Medicine Trials Network for HIV/AIDS Intervention, Neurological Emergencies Treatment Trials Network, Pediatric Emergency Care Applied Research Network, and the Children s Oncology Group. The concept proposal included in this application builds on prior CPCCRN research, led by Dr. Meert, demonstrating many challenges to achieving high quality parent-clinician communication in PICUs. High quality communication is especially important for parents with low health literacy, a key contributing factor to child health disparities. Patient- and family-centered communication (PFCC) may improve the quality of communication but depends, in part, on parents active participation (e.g., question asking) during clinical interactions. The objective of the concept proposal is to develop a novel communication intervention, the Question Prompt Toolkit; and determine the extent to which the intervention can enhance PFCC in PICUs, and thus improve child and family outcomes. The central hypothesis is that use of the Question Prompt Toolkit will increase parents active participation in clinical interactions, knowledge, self-efficacy and trust, reduce parent's anxiety, and ultimately contribute to better health-related quality of life for the child and reduced family burden, especially for families with low health literacy. The hypothesis will be tested in multicenter research that pursues 2 specific aims: (1) Develop the Question Prompt Toolkit for use among parents of critically-ill children; and (2) Determine the extent to which the Question Prompt Toolkit can enhance the use of PFCC in PICUs and improve child and family outcomes. The proposal is significant because it will contribute a new communication intervention that can be applied in PICU practice to address parents' communication needs and improve health outcomes.